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2027 Maternity Resource Center

A new chapter in maternity billing.
Get ready for 2027.

Global maternity coding is changing. Follow payer guidance, understand the transition, and prepare your practice for each encounter.

Check your readinessExplore payer guidance

Your transition toolkit

From policy to a plan.

Compare payer instructions

Review the source, scope, and open questions in one billing rubric.

Open the billing rubric

Check an encounter

Compare hypothetical encounter details with reviewed payer rules.

Open the encounter checker

Find your readiness gaps

Ten questions. A clear score. Your next steps for the transition.

Take the readiness check

Payer policy explorer

Start with your payer.

Find the source behind the status. Check the exact product and effective date before applying any guidance.

Showing 5 of 5 payers & programs

Aetna

NationalCommercial · Medicare Advantage

Confirmed 2027 guidance

For expected 2027 deliveries, the bulletin describes September–December preventive prenatal billing and a threshold of three versus four visits in 2026.

Transition starts
Sep 1, 2026
Billing starts
Jan 1, 2027
Checked Sep 30, 2026View evidence & scope

Scope. Commercial and Medicare members. Texas fully insured plans are subject to the regulatory qualification in the bulletin; confirm the exact product.

Global billing. The announced 2027 framework retires global codes. Claims-processing details are still forthcoming.

E/M documentation. Routine and non-routine visits have different modifier and cost-sharing instructions. Do not choose an E/M level from visit number alone.

Aetna · Published 2026-09 · Checked Sep 30, 2026

OfficeLink Updates, September 2026 (printed pages 8–10)
“This update applies to commercial and Medicare members.”
Full payer recordReport an issue

Blue Cross NC

North CarolinaCommercial

Awareness notice only

The notice references preparation beginning in mid-May 2026 for services in 2027. No exact transition day is supplied.

Transition starts
Not stated
Billing starts
Not stated
Checked Sep 30, 2026View evidence & scope

Scope. Blue Cross NC provider announcement. Product-specific applicability and operational rules require confirmation.

Global billing. The notice announces alignment with the AMA changes; it is not a complete claim-submission policy.

E/M documentation. The announcement does not specify an E/M code family, modifier, or encounter-level decision rule.

Blue Cross NC · Published 2026-05-26 · Checked Sep 30, 2026

Changes to billing for global maternity services
“Additional guidance and resources will be shared in the coming months.”
Full payer recordReport an issue

Capital Blue Cross

PennsylvaniaCommercial · Medicare Advantage · CHIP

Confirmed 2027 guidance

July guidance introduces visit-based reporting from September 1. A later bulletin updates modifier instructions effective November 1, 2026.

Transition starts
Sep 1, 2026
Billing starts
Not stated
Checked Sep 30, 2026View evidence & scope

Scope. Pennsylvania programs listed in the administrative bulletins. Verify product and FP-01.011 applicability.

Global billing. Use the current FP-01.011 policy and both bulletins together; the September update changes earlier modifier guidance.

E/M documentation. The November update extends TH to maternity-related procedure codes beyond E/M. Check the source for applicable services.

Capital Blue Cross · Published 2026-07-01 · Checked Sep 30, 2026

July 2026 administrative bulletin: FP-01.011
“transitioning away from global obstetric codes in favor of visit-based service reporting.”

Capital Blue Cross · Published 2026-09-01 · Checked Sep 30, 2026

September 2026 update to FP-01.011
“Providers must append HCPCS modifier TH to all maternity-related procedure codes”
Full payer recordReport an issue

Cigna Healthcare

NationalCommercial

Pending payer guidance

The September 14 update retains the existing billing process and promises more 2027 guidance later in the year.

Transition starts
Not stated
Billing starts
Not stated
Checked Sep 30, 2026View evidence & scope

Scope. Cigna Healthcare provider guidance. Do not extend this record to separately administered or affiliated products.

Global billing. Continue to follow current contractual and reimbursement requirements. The announcement does not establish a 2027 transition date.

E/M documentation. The source cautions against changing prenatal E/M reporting solely on the basis of the proposed transition approach.

Cigna Healthcare · Published 2026-09-14 · Checked Sep 30, 2026

Update on maternity coding and reimbursement
“Cigna Healthcare is not changing its current maternity billing guidance at this time.”
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North Carolina Medicaid

North CarolinaMedicaid FFS · Medicaid managed care

Confirmed 2027 guidance

September transition guidance encourages E/M reporting for specified prenatal encounters. Individual E/M billing is not mandatory before 2027.

Transition starts
Sep 1, 2026
Billing starts
Jan 1, 2027
Checked Sep 30, 2026View evidence & scope

Scope. NC Medicaid Direct and NC Medicaid Managed Care. This is one state-program record, not a separate confirmation for each managed care plan.

Global billing. The bulletin retains existing options for episodes completed before 2027 and announces the January fee-schedule change.

E/M documentation. The source calls for supporting MDM or time and gestational-week diagnosis information. Read the full eligibility and timing conditions.

NC Medicaid · Published 2026-07-10 · Checked Sep 30, 2026

Transition to AMA maternity CPT 2027 code changes
“Health plans may not require the use of individual E/M codes in lieu of current bundled codes”
Full payer recordReport an issue

The coding shift

One episode. Four phases of care.

The AMA’s 2027 framework separates reporting across the maternity journey. Payer implementation remains a separate check.

17codes deleted

12codes added

6codes revised

Full code changes from the AMA
01

Antepartum

Prenatal care shifts to encounter-level E/M reporting.

02

Labor management

Separate reporting reflects the days of labor care.

03

Delivery

Delivery services have a distinct coding framework.

04

Postpartum

Postpartum E/M is reported per encounter, with same-day delivery exceptions.

Beyond the transition date

Every encounter needs
documentation that holds up.

A payer timeline is the starting point. Your coding team still needs to evaluate each encounter’s documentation and the applicable E/M rules.

Request a prenatal E/M audit

Routine follow-up

Review what was assessed and managed. A routine visit label does not, by itself, establish an E/M level.

A more complex encounter

Make sure the record supports the work performed. A high-risk pregnancy diagnosis alone is not a level-selection rule.

Explore the encounter checker

Research log

Recently added to the tracker.

All updates →

Aetna

Initial source record added · Clinical review pending

Sep 30, 2026

Blue Cross NC

Initial source record added · Clinical review pending

Sep 30, 2026

Capital Blue Cross

Initial source record added · Clinical review pending

Sep 30, 2026

Common questions

A little clarity goes a long way.

Does every payer change on January 1, 2027?

That is the CPT effective date. Payer implementation, transition rules, and contract requirements need to be checked separately. A published announcement may still leave claims-processing details unresolved.

What if prenatal care starts in 2026 and delivery is in 2027?

Check the payer’s cross-year guidance before changing your billing workflow. Service dates, expected delivery, completed visits, and the end of postpartum care can affect which instruction applies.

Does a confirmed status mean my claim will be paid?

No. It means the cited payer source contains 2027 guidance. Product applicability, documentation, contracts, and claim edits still matter. Ember’s clinical review is pending.

Should every prenatal visit use the same E/M level?

No level is assigned by this resource. Review the applicable E/M guidelines and the documentation for the individual encounter with your coding team.

Do all payers require modifier TH?

No universal instruction is implied. Look for the exact payer, product, service, and effective date. The presence of a modifier alone does not establish coverage or preventive status.

Can I use commercial guidance for Medicaid?

Do not assume it applies. State Medicaid programs and managed care products may publish their own instructions. Filter by line of business and verify the member’s plan.

Why is a transition date missing?

The cited source does not provide a precise date that can safely be recorded. We leave unknown values empty rather than substitute the CPT effective date.

Can I enter patient information in these tools?

Use hypothetical encounters only. Do not enter patient names, record numbers, member IDs, or other identifying information. The encounter checker runs in your browser.

How do I save or share what I find?

Explorer and rubric filters are in the page URL. The checker’s explicit share action puts hypothetical inputs in the link fragment. You can export the filtered rubric or print your readiness result.